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Akifumi Suzuki and Nobuyuki Yasui

P revious reports have described the usefulness of cortical surface recording of somatosensory evoked potentials (SEP's) for the functional localization of the human cortex during surgery. 1–5, 7, 8 Since 1985, we have recorded SEP's from the exposed cortical surface to localize the central sulcus in surgery. We have recently treated a patient who showed perplexing findings for determining the central sulcus. We report this case and describe a potential pitfall in the clinical application of cortical SEP's for functional localization of the sensorimotor

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Wajd N. Al-Holou, Dima Suki, Tiffany R. Hodges, Richard G. Everson, Jacob Freeman, Sherise D. Ferguson, Ian E. McCutcheon, Sujit S. Prabhu, Jeffrey S. Weinberg, Raymond Sawaya, and Frederick F. Lang

) technique in which the tumor is resected from the center toward the edges. This approach is often recommended because the resection remains within the tumor, avoiding the surrounding healthy brain. In contrast, at our institution we have increasingly used a circumferential or sulcus-guided resection (SGR) technique, in which the edges of the tumor are defined at the beginning of the resection by using the surrounding sulci as a guide, and the tumor is resected circumferentially at its interface with the surrounding brain and sulci without ever entering the tumor core

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Daniel Dutra Cavalcanti, Bárbara Albuquerque Morais, Eberval Gadelha Figueiredo, Robert F. Spetzler, and Mark C. Preul

of cavernous malformations and brainstem tumors. 1 , 3 , 4 , 7 , 10 , 11 , 24 , 25 , 29 , 31 , 38 The lateral mesencephalic sulcus (LMS) is the preferred route and is related to major anatomical structures such as the trochlear nerve , superior cerebellar artery (SCA), and distal branches of the posterior cerebral artery (PCA). Different surgical approaches to the midbrain surface have been described, including subtemporal (ST), median supracerebellar infratentorial (SCIT), 22 , 33 paramedian SCIT variant, 37 , 39 and extreme-lateral SCIT variant. 34 , 35

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Baotian Zhao, Chao Zhang, Xiu Wang, Yao Wang, Chang Liu, Jiajie Mo, Zhong Zheng, Kai Zhang, Xiao-qiu Shao, Wenhan Hu, and Jianguo Zhang

surgery has been widely reported. 17–19 However, small lesions are more likely to be found at the bottom of a sulcus, which has been termed “bottom-of-sulcus dysplasia” (BOSD) in the literature. 20 , 21 Our previous quantitative neuroimaging study confirmed such results based on morphometric MRI analyses. 4 Furthermore, we found that seizure onset and interictal high-frequency oscillations most often arose from dysplasia found at the bottom of a sulcus in FCD II. 22 Considering the preferential location of small FCD II lesions at the bottom of a

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Koshiro Nishikuni and Guilherme Carvalhal Ribas

understanding of the anatomy, but also for dealing with practical gestational, neuroradiological, and microneurosurgical issues. F ig . 1. Development of sulci of the superolateral cerebral surface in the fetus at 17 (A) , 24 (B) , and 36 weeks (C) , and at 1 postnatal week (D) . CS = central sulcus; IFS = inferior frontal sulcus; IHF = interhemispheric fissure (longitudinal cerebral fissure); IPS = intraparietal sulcus; ITS = inferior temporal sulcus; OrbS = orbital sulcus; OTS = occipitotemporal sulcus; PostCS = postcentral sulcus; PreCS = precentral sulcus; SFS

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Yasser Jeelani, Abdulkerim Gokoglu, Tomer Anor, Ossama Al-Mefty, and Alan R. Cohen

arteriovenous malformations. 20 Conventional transtemporal approaches may injure eloquent cortex—surgery may thus be associated with various postoperative deficits, depending on the approach chosen. 9 The supracerebellar transtentorial approach to the ventricular atrium provides a minimally invasive corridor by traversing the medially located collateral sulcus, while minimizing cortical disruption by virtue of the sulcus' anatomical proximity to the ventricular atrium 8 ( Fig. 1 ). With proper head positioning, this approach may involve minimal retraction of the

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Jesús Pujol, Gerardo Conesa, Joan Deus, Luis López-Obarrio, Fabián Isamat, and Antoni Capdevila

T he central sulcus is a major anatomical and functional reference in neurosurgery, and its identification is required for surgery aimed at removing centrally located lesions. Magnetic resonance (MR) imaging now provides tools to recognize the central sulcus functionally and to visualize its location preoperatively in relation to the surgical target. 3 By means of functional sequences, we are able to detect primary sensorimotor cortex activation on MR imaging. Extensive research conducted in healthy volunteers has yielded a comprehensive knowledge of the

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Feng Wang, Tao Sun, Xing-Gang Li, and Na-Jia Liu

T he temporal stem overlying the inferior limiting sulcus of the insula and the lateral superior margin of the temporal horn 3–5 , 10 , 11 , 16 , 18 , 22 , 38 is the white matter bridge between the anterior temporal lobe and thalamus and the brainstem and frontal lobe. Dysfunction of the temporal stem, resulting from congenital, traumatic, surgical, or degenerative disconnection of the temporal and frontal lobes, is involved in a number of cerebral disorders. This structure is also a critical landmark for the transinsular surgical trajectory to the

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Eisha A. Christian, Elysa Widjaja, Ayako Ochi, Hiroshi Otsubo, Stephanie Holowka, Elizabeth Donner, Shelly K. Weiss, Cristina Go, James Drake, O. Carter Snead, and James T. Rutka

R esection of the epileptogenic lesion in patients with medically refractory epilepsy can result in a seizure-free outcome. Lesions such as focal cortical dysplasia (FCD) at the bottom of the sulcus (BOSD) are highly epileptogenic and are often small. These lesions are difficult to identify on MRI because of their small size and subtle imaging features. 2 , 5 Invasive intracranial monitoring with depth electrodes and subdural strips and grids is often used to confirm that the putative lesion is the primary zone of epileptogenesis, as well as to map the location

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M. Yashar S. Kalani, Kaan Yağmurlu, Nikolay L. Martirosyan, and Robert F. Spetzler

course of the fourth nerve and branches of the superior cerebellar artery over the lateral mesencephalic sulcus. The lateral mesencephalic sulcus has been described as a safe entry zone for resection of lesions located laterally at the level of the mesencephalon and upper pons. The fourth nerve can be traversing the sulcus (1:18) . For the lateral supracerebellar infratentorial craniotomy the patient is placed supine with the head turned to the contralateral side and the chin tucked. It is important to place the craniotomy at the junction of the transverse and sigmoid